Annotated Bibliography:

Risks Associated with Pediatric Diagnostic Radiology

Elizabeth Muha

April 26, 2015

Linet MS, Kim KP, Rajaraman P. Children's exposure to diagnostic medical radiation and cancer
risk: Epidemiologic and dosimetric considerations. Pediatr Radiol. 2009; 39(S1): S4-S46
1. Children's Exposure to Diagnostic Medical Radiation and Cancer Risk: Epidemiologic and
Dosimetric Considerations
This quantitative research study addresses the issue of pediatric exposure to radiation
during diagnostic procedures like X-Rays and CT scans. While the causation and origination of
childhood cancers remains largely unknown, epidemiological studies consistently suggest a
relationship between the exposure to medical radiation during pregnancy and a resulting
occurrence of childhood cancer in the offspring of exposed mothers. In addition, it does seem
clear that cancer risks from all forms of radiation are definitely cumulative, and that cancer
continues to increase decades after initial exposure thus making in-utero infant exposure of
concern.
The researchers used current and historical data related to radiological dosage for
pediatric procedures in order to calculate cancer risk estimates. Other factors that were taken
into consideration include the child's age, radiation exposure time, and the medical reasons for
the procedures1. The researchers determined that while the overall rate of childhood cancers is
low, children tend to receive higher dosages for longer periods of time than adults; however,
there are fewer studies related to cancer risk in pediatric patients from radiation exposure than
there are with adult patients and that more studies are required1.
The reliability and validity of this study may have been impacted by the fact that this is
an epidemiological study, meaning that there are factors that can influence the study results and
which are beyond the control of the researchers1. This research paper would be helpful in my
clinical practice because it illustrates that there is a great deal that is not known regarding
pediatric exposure to radiation during diagnostic procedures Additionally, the researchers also

discuss how parental preconceptions about radiation exposure can impact upon diagnostic
procedures, something that is valuable to know since I will be working with parents and their
children. More broadly this article impacts clinical practice by increasing awareness. Practitioner
and their associated staff need to consider more specifically; exposure settings, must promote
education in the radiological sciences, and need to provide recommended and standardized
protocols to reduce radiation exposure.

Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimated risks of radiation-induced fatal cancer
from pediatric CT. Am J Roentgenol. 2001; 176(2): 289-296.
2. Estimated Risks of Radiation-Induced Fatal Cancer from Pediatric CT

This qualitative research study sought to determine whether children who received CT
scans were more likely to die from cancer over their lifetime. In light of the rapidly increasing
frequency of CT exams, the study found it imperative to assess the lifetime cancer mortality risks
attributable to radiation from pediatric CT. The best available risk assessments suggest that
pediatric CT will result in significantly increased lifetime radiation risk over adult CT both
because of the increased dose per millianpere-second, and the increased lifetime risk per unit
dose.
Mathematical extrapolations were conducted based on low to intermediate dosages at
organ sites common for CT examinations2 and estimated risk factors. The researchers determined
that there is a greater risk involved in pediatric CT than in adult CT because of dosage levels and
exposure time, and that the increased frequency with which children are being exposed to CT
merits further investigation2.

This research study is both reliable and valid because the researchers consistently looked
at the same elements in multiple patients/studies in what appears to be an accurate fashion. This
research study would be useful in my clinical practice because it discusses how dosages can be
lowered, thus minimizing patients' exposure, with little loss of information for the purposes of
diagnostics. From a clinical perspective it further validates the need to establish consistent and
recommended protocols that promote and secure effective, but as low as needed exposure
guidelines.

Brody AS, Frush DP, Huda W, Brent RL. Radiation risk to children from computed tomography.
Pediatrics. 2007; 120: 677-682.
3. Radiation Risk to Children from Computed Tomography

This qualitative research study evaluated the cancer risk experienced by pediatric patients
during computed tomography procedures. Imaging studies that use ionizing radiation are an
essential tool for the evaluation of many disorders of childhood. Computed tomography is of
particular interest because of its relatively high radiation dose and wide use. Of most importance
is whether the benefits of this testing outweigh the associated risk of potentially increasing
cancer development.
Using a range of sources, the researchers discussed the use of CT procedures for
diagnostic purposes in pediatric patients as well as the role of radiologists in minimizing the
dosage of radiation received by pediatric patients3. This report and study was more of a literature
review as opposed to a research study. It was intended to serve as a resource for pediatric

healthcare professionals to primarily improve understanding of pediatric CT radiation and its

potential risks. The researchers determined that the benefit of CT procedures outweighed the risk
of radiation exposure and the subsequent development of cancers3. While this report would be
helpful to me in my clinical practice, given that it summarizes many key issues associated with
radiology, CT scans, and pediatric patients, the researchers did not develop any new information
based on the data that they examined; rather, they simply took preexisting studies and presented
the information in a succinct manner for the benefit of radiologists, physicians, and parents.
However I believe even practitioners and medical staff must always be learning and
communicating, this assures efficiency and success within the practice of all aspects of medicine.
The information was indeed valid and accurate in as far as the authors truthfully represented and
presented the information provided to the best of their ability. No actual research was conducted
so there was potentially no margin of error.
References
1. Linet MS, Kim KP, Rajaraman P. Children's exposure to diagnostic medical radiation and
cancer risk: Epidemiologic and dosimetric considerations. Pediatr Radiol. 2009; 39(S1):
S4-S46
2. Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimated risks of radiation-induced fatal
cancer from pediatric CT. Am J Roentgenol. 2001; 176(2): 289-296.
3. Brody AS, Frush DP, Huda W, Brent RL. Radiation risk to children from computed
tomography. Pediatrics. 2007; 120: 677-682.